Assessing Frailty in Plastic Surgery: Analysis of the Five-factor Index

Background: Frailty has been shown to have a strong association with adverse outcomes in several surgical specialties. Only recently, however, its relevance in plastic surgery has been examined, yielding inconsistent results. Our goal was to apply the five-factor modified frailty index (mFI-5) across multiple subcategories of plastic surgery procedures to identify potential areas where it might prove useful. Methods: NSQIP data from 2015 to 2019 were utilized. Plastic surgery CPT codes were placed into clinically relevant subcategories based on common procedure groupings as follows: superficial soft tissue procedures, head and neck reconstruction, hand surgery, breast reconstruction, gender surgery, esthetic surgery, and facial fractures. The mFI-5 score was calculated for each subcategory. C-statistics were used to determine predictive ability for 30-day morbidity. Multivariable logistic regressions were also calculated to assess for odds ratios (ORs) with regard to 30-day morbidity. Results: A total of 188,741 patients fit inclusion criteria. The mean frailty of plastic surgery patients was noted to be lower than in other surgical specialties. C-statistic models and ORs showed mFI-5 to have predictive ability for post-operative complication in superficial soft tissue procedures (C stat: 0.758), hand surgery (C-stat: 0.832), breast reconstruction (C-statistic: 0.718), head and neck reconstruction (C-statistic: 0.735), and gender surgery (C-statistic: 0.732). Conclusion: The mFI-5 is a clinical tool that can be selectively and cautiously used in plastic surgery, for specific subcategories of procedures including soft tissue procedures, hand surgery, head and neck reconstruction, and breast reconstruction.